Cardio Choices and how They Affect Your Pelvic Floor

Let’s talk about cardio. I know there are a lot of questions about what women can and can’t do for cardio when experiencing prolapse and/or incontinence symptoms. This happens to be a loaded question because the answer is dependent on your conditioning level, your over-all strength, and your symptoms of pelvic floor dysfunction. So while I can’t give you any “definite” on what you should or should not do, I can provide some thoughts that may help guide you.

To begin, it’s important to have an understanding of all the muscles of your pelvic basket and how to activate those muscles. Establishing a baseline strength of these deep core muscles through appropriate strengthening exercises is important before beginning any cardio. When you begin with a solid base strength, you will continue to build on this strength as you introduce cardio, further decreasing your symptoms. If you skip the base-building step, you will more than likely note increased symptoms with cardio activities. With this understanding, we can move forward and discuss the positives and negatives of many cardio choices.

Let’s first talk about walking for fitness. Walking is a fantastic activity. However, I would like to give a few tips to make your walking better for your body and for your pelvic floor. The first tip is to focus on your push off. Feel your toes (your big toe especially) work to push you forward. This simple change of focus will decrease your heel strike and decrease the force of impact of every step. It also promotes hip extension and naturally lifts your chest. You will feel like you are walking taller, which is a good thing!!!

Now let’s talk about swimming. It is one of the best cardio choices for women experiencing pelvic floor dysfunction. Actually, it is one of the best cardio choices for anyone. It is an exercise that works both upper and lower body muscles and it promotes extension as you stretch your body out in the water. As you work to balance your body in the water and work your swimming strokes, it works the many stabilizing muscles, including your transversus abdominus (TA) and multifidi that are so important to pelvic floor recovery. So swimming gets a big thumbs-up from me. For those of you who just don’t like to put your face in the water, you are still not off the hook! You can get in the water holding a kick board with your arms and your head above water, allowing you to still work your lower body in an extended position.

How about biking? Again, I like this exercise because of the position it puts your body in. A good bike fitting will require you to reach forward to your handle bars which will roll you forward onto your sitting tripod, which is your right sit bone, your left sit bone, and your pubic bone. This is a position that frees your tail bone from pressure and automatically activates your TA because of the forward reach of your arms. Biking is a great form of cardio that will have a positive effect on pelvic floor symptoms
simply because of the positioning alone.

Let’s move on to cross country skiing. This is an excellent non-impact form of cardio that also promotes extension since it is focused on hip extension and push-off on every stroke. Again, it is both an upper and lower body workout that will enhance pelvic floor strength if you have already established a solid base strength AND provides exceptional cardiovascular conditioning.

The four exercises I discussed – walking, swimming, biking, and cross country skiing – alll get a thumbs up from me, and you would do well to rotate these exercises into your weekly routine. Now let’s talk about some of the more controversial or
demanding forms of cardio.

We’ll first talk about running because it is an activity that many of us love and want to continue for years to come. I will speak from a personal stand point and I encourage any of you to share your stories as well. I have been running since discovering my prolpase 8 years ago and my pelvic floor is better conditioned today than it has been since discovering my prolapse. That being said, I think I am a different runner than I used to be. I don’t run on consecutive days, instead I cross train every other day. Is this because of my pelvic floor or my knees or my hips…probably for the recovery of all three! My body responds well to rotating impact and non-impact activities. Also, I pay attention to my running style, taking care to limit my heel strike and on hill running days, I now walk back down the hill instead of running down, again to limit heavy heel contact and pounding on my body. What I do get out of running is exceptional cardiovascular conditioning with both endurance runs and high intensity interval training. My personal story is that my pelvic floor is its strongest right at the peak of my triathalon training. It is a positive story that lets you know that you don’t have to give up running. However, there simply is no research at this point to support or dispute this…just personal stories. So share yours, positive or negative, about running with prolapse, so that other women can read and learn as well.

Finally let me cover a couple of other cardio choices that have come up. The elliptical machine is one that many women like because it is lower impact. My concern with the elliptical machine is the focus on flexion. Your hips flex forward but there is minimal to no hip extension on the elliptical machine. If you love this machine and choose this as your form of cardio, then be sure to work in at least 2 hip extension exercises following your elliptical workout.

Kickboxing is another workout that many women ask about. This is a tough one, because although I recognize that it provides an excellent power and cardiovascular conditioning, it is very difficult not to increase your intra-abdominal pressure when you kick or punch. These power strikes that produce a sudden increase of downward pressure on your pelvic floor are tough on supportive tissues that aren’t 100%. It is never a problem to try an activity like kickboxing, but if you feel increased pressure on your pelvic floor with every kick or punch, it is probably not your best choice for cardio.

Hope this information is helpful as a guide. Please feel free to ask questions and share your personal stories as well.

Published by Tasha

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25 Comments

Your Comments Hi Tasha,
What about the walk at home exercise tapes? There is some lateral movement, low kicks, and high knee lifts. Also, when it comes to punching, would the pelvic floor be protected if you tightened your ta before throwing the punch? Thanks so much for the information.

I used to run long distances until 3y ago when my first child was born. I finally am getting back into a regular exercise routine (pathetic as it may be) in the mornings before work. I have been doing 10-15min on elliptical and then two advanced dvd exercises. It is very boring, and I hope once I wean my daughter I’ll have more morning freedom to bike or walk. I am still hesitant to run…although my physician said that running would actually strengthen the pelvic floor and that with every foot strike there is a reflex tightening of those muscles.

I appreciate the tip regarding the hip extension exercises, so I will favor those post-elliptical.

Are there other tips that would be best on this machine – for some reason I find myself standing more upright and not using the moving arm handles. It seems like a better work out but also easier to feel the TVA.

Anne,
I am not familiar with the “Walk at home” tapes, but I say yes to lateral movement and high knees. I do a regimen of lateral walk or shuffle, backward walk or run, high knees, and butt kicks after every walk or run that I take.

As for punching. Yes, you can definitely help by contracting your TA and also breathing out as you punch. If you contact a bag, the punch will increase your intra-abdominal pressure and may have a negative effect on your prolapse symptoms. This is something each individual will have to evaluate for themselves.

Emily,
Don’t be so hard on yourself. It is such a busy time as a new mom and even after you are a “not-so-new” mom. Getting back into regular workouts is a process so it will come.

As for tips on the elliptical. I like the no arms approach because you are forward flexed a bit less and that’s why you can feel your TA more. You can also try turning around on the elliptical machine.

Finally, I agree with your physician and it sounds like you want to return to running. You can start with just a mile and work your way up slowly, monitoring your symptoms. I would encourage you to go in this direction. It will give you increased energy and it definitely won’t be so “boring”. Be sure, no matter what your cardio choice, that you continue with your stabilization exercises – they are important!

Dear Tasha,
Thanks for your response. I do not use a punching bag, but I will use caution with any punch I throw during cardio. The information you share is something I know I can rely on. Thanks again.

Thanks for the advice Tasha!
I’m still early postpartum but when things will be better, i really hope i can get back to running because it was my passion before prolapse and i really miss it and how good it make me feel.

Your article gave me hope it will be possible one day 🙂
For now I will focus on biking and walking

Hi Tasha
Thanks for all of your fabulous posts, I really feel like I am doing something positive for myself and my prolapse just reading the blog and empowering myself. I am interested to know why you specifically favour extension exercises for prolapse? is it because most extension activities do not increase downward pressure as flexion may do? I ask this also from a position of someone who did clinical pilates for 9 months post prolapse, at times I was put into very strong flexion positions, and this was by a women’s health physio. I cannot help but question if this would have been appropriate for me. Granted I was suffering extreme back pain at the time too so maybe the flexion was good for the back and the pelvic floor was put aside at the time. I sure hope not. :/
My Hab-it dvd recently arrived, I am really enjoying workout 1. 🙂

LK,
I focus on extension for several reasons. The first being what you have described about compressing our abdominal and pelvic cavities in flexion vs. opening them up and lifting all connective tissue and organs when extending. The second is for muscle efficiency. If our pelvic floor muscles are attached to our tail bone and our pubic bone and we flex our tail bone forward, then we lose the healthy tension we should have in our pelvic floor muscles. If we are always strengthening in this way, then we reinforce this bad posture and our tail bone will remain “tucked under” throughout our day because this is what we keep reinforcing with exercise. Which brings me to my final reason for loving extension….Posture!!! Everything we do throughout our day flexes us because everything takes place out in front of our bodies, plus we sit alot, and we tend to sleep all curled up. Then when we go to stand up, gravity pulls us forward. Our shoulders slouch, our bellies hang loose and our pelvis likes to rock to one extreme or another, taking us out of our neutral spine. You see the progression of this forward flexed posture as people age and they get an exaggerated hump in their back, their head hangs forward, etc. So working extension reinforces our neutral spine posture, strengthening against the effects of gravity, weight, and laziness. Holding neutral spine posture allows your ribs to expand effectively, bringing in more air with each breath, it allows your joints to move freely in a pain free range, it allows for maximum blood flow and clear neural pathways, and it holds the attachment sites of your muscles in the correct position, so you your muscles can work effectively.

Boy do I love to talk about posture!!!

Glad you have started the workouts. Keep us informed of your progress.

I just thought I would share my experience with martial arts, and then ask a question. : )

Prior to the birth of my second child and the discovery of a prolapse, I had practiced martial arts (a style of kung fu) for four and 1/2 years. I had also been running long distance since I was 12.

Bypassing all the shock, anger, and sadness that came with “the discovery,” I found Hab-It, faithfully did the workouts every other day for 8 weeks and then graduated to the 7 day advanced program. I worked through 3 full cycles, working out every day, before I attempted to go back to my martial arts practice. I had been doing some elliptical running and some forms with fantastic results, but was crazy nervous my first day back.

It was wonderful! I kicked, punched, took many falls, and even grappled. Through all of it, I never felt any problems or experienced any tension build up on my pelvic floor. I have now been back for over a month and , if anything, feel tighter and in better shape.

Now, I stay very relaxed during class and have a very powerful focus, (my exhale upon striking) and have practiced seriously for years. But, I hope my experience will help other martial artists feel encouraged to get back to what they love. I start sparring again next week…

And this leads to my question. It is important for me to have a strong core to prevent injury during sparring. I have asked before about ab strengthening and am not doing any crunches or sit-ups, but are there any exercises I can use to, for lack of a better term, harden the abs up near my solar plexus? It is very likely I will experience strikes to this area and am wondering how to work this area without typical ab work. My trans abs and obliques are starting to feel and look great due to your workouts, but this area up near the ribs still feels pretty mushy. I am still just under 6 months postpartum, but there is such a difference between these areas.

I have experimented with getting into extreme extension on a ball, with my toes under a bench so my head and shoulders are below my hips, and doing mini crunches from extreme extension into neutral. What are your thoughts on this? I know getting back to running wil help. If I just continue with the 7-day workouts will my core tighten all the way up?

Thanks for all your help and expertise!!
Holly

p.s. If you ever decided to create a workout program (like p90x for pelvic floor), it would be amazing! You would be such an inspirational host. Just a thought. : )

Holly,
Thank you for sharing your advanced recovery! So many of you have successfully returned back to advanced activities and I appreciate the shared story for other women to read! Yours is the first shared story on a return to martial arts and will be a great reference.

I note that you are just 6 months pp, so remember your body is still healing and remodeling – so continue with your good work and consistent effort on posture. As for your question on developing your rectus muscle to protect your solar plexus – I totally understand WHY this is important for your sport, but I am unsure of treading into this territory.

That being said, if you are determined to try, then my advice is to take it really slow. Keep the remainder of your routine consistent so you can read your body and recognize if you are adversely affecting your prolapse in your effort to develop this muscular area. Your current method of working a crunch from extreme extension to neutral is too hard on your vertebrae and discs due to the excessive compression force. But I do like the inverted position, so try to position yourself on a workout bench so your head is lower than your hips, but your spine is in neutral and you can work some crunches in this position. I would highly recommend you work these crunches just MWF to begin and read your body’s response. Only work your rectus to gain the strength you need but you don’t want your RA taking over for your TA or I believe you will have future problems.

Thanks so much for your response. As an update, I returned to sparring this week and again had no issues, whatsoever! I am not going quite full speed and power at this point, just to make sure I am do not overdoing it (not to mention my cardio needs work). I will give myself a couple months before I go 100%.

Also, thank you for your thoughts on the RA versus TA. I was struck in the stomach/solar plexus area several times during each bout and had no issues. My TA automatically tightened as needed and everything else seemed to tighten from the bottom up. I did not feel the need for that extra RA strength. The 7-day advanced program had apparently strengthened my whole core more than enough to prevent injuries or that uncomfortable loss of breath feeling.

In the future I may try out the light crunches you have outlined, but I am not certain I will even need it. I do intend to continue the exercises of the advanced program, along with my other workouts, indefinitely.

Hi Tasha; I have just recently been introduced to your program and blog. I have been dealing with what started as a bladder prolapse post menapause, to now what has developed into a full on uterine prolapse. I have had two children, and have never had any type of hysterectomy and am terrified of the surgeries available and possibilities of failure only to end up with a worse situation than I’m in now. I have always been and still am very active and approaching 60. The lack of estrogen at my age now is not in my favor I’m sure. Was a runner for years, taught dance and conditioning, I hike and ski and have obviously had to change my activities as a result of this. I did take a trip to see Dr. Moore of Miklos and Moore in Atlanta last year and am contemplating surgery, but wanted to point out the cardio activities that work best for me.

Since I live in a mountain town and ski resort, I always look for uphill walks and hike our ski hill quite often winter and summer or local walks with uphill mixed with gentle downhill as this keeps my bladder forward and I do not have to stop and find the ladies room in the woods as often, as I might have to when I walk on the flat. Cross country skiing also is helpful in that regard being more forward, and the elliptical works well for me if I combine it with a walk on the treadmill, and of course biking is great. I have had to give up running and dance which I miss, but I appreciate what I can do.

I am considering your exercise program, and wonder if you have you ever seen a woman able to get her core back when the uterus has prolapsed? if there was a way for my body to heal by itself this of course is what I would prefer. I have been working on my core my whole life, although I can’t say I have been as specific as your program, (although I do not exactly know what your program is) and am willing to give it a try. Just curious your thoughts? My gut tells me I really should consider surgery, and of course there would be the rehab after, but if I could avoid this I would……

Mary,
Remember this – even if your choice eventually becomes surgery, you would want this exact program to strengthen your entire pelvic basket post surgery. So the positives in working the Hab It program are there with or without surgery.

A couple of thoughts from me…I want to refer you to http://www.prolapsehealth.com There are a good number of post menopause women on this site sharing there personal stories about controlling their prolapse symptoms.
Second, from my corner, I want to encourage you to trust your body. No matter what your age, you can make positive changes, especially with a base fitness level like you have. When working the Hab It exercises, take care to go slow and isolate each of the muscles of your pelvic basket as instructed on the dvd before moving forward through the different workouts. Also, with your activity level, you would benefit from the Advanced Workout on this site. However it is important for you to set your muscle firing pattern with 4 weeks of consistent progression through the Hab It dvd as well as daily awareness of your posture. Go slow, be deliberate, be consistent to re-set your firing pattern and I am confident you will see results.

Hi Tasha;
Just wanted to let you know that I ordered your dvd and look forward to my last ditch effort to strengthen my basket before I make a final decision on surgery. I will keep you posted as to my progress and appreciate your specific advice. I taught dance and conditioning for many years as well, and had to give up my classes for various reasons, this issue included. I’m in pretty good shape for the shape I’m in as my father always said, and this has been a journey. I miss running and dance but appreciate being as active as I am. I will let you know how it’s going. I have been looking for a place to connect with others with the same issues so thanks for the website and place to share successes and failures with and without surgery.
Best, Mary

Hi Tasha,
Thank you so much for the information on neutral spine and bicycling. I have SI joint issues and my PT worked with me on changing my flat back to neutral. She thought is would help to resolve the SI joint problems but didn’t go into nearly as much detail as you do. She also didn’t know how to explain how to sit when I’m riding my bike. Neither did my bike fitter.
My bike is custom and very well fitted to me for my “flat” spine. I rode today and am able to hold the position you describe for a neutral spine but I would like to know if changing the position of the spine requires a change in the saddle position. It seems I was riding farther away from the pedals than normal. Is this possible?
Also, I laid on my stomach for a few minutes today and the position had my cranky SI joint talking. Any thoughts as to why this is. I’m not totally pain free but it mostly complains when I’m sitting. I was released from PT in Jan. and once again am trying to “figure this out on my own”.

Kathi,
Your PT is right on. Working to find and to hold that neutral spine posture is best for your SI. Your Multifidi, TA, and pelvic floor are the three deepest stabilizers of your pelvis and SI joints. Working these muscles regularly with be of great benefit for you for years to come. Read through any and all of my posture blogs, including anything I have on TA vs. RA and multifidi.

As for your bike. Yes! by rolling your pelvis forward to be in more of a neutral spine position, you actually move the attachment site of your hamstrings so in a sense, this would require you to adjust your seat position to prevent you from reaching to far for your pedals. A slight adjustment should do the trick.

Finally, when you lay on your stomach, place a pillow under your hips. You may not be ready for this much extension yet?

Tasha,
I tried to run this past weekend for the first time in three years since discovering a prolapse!
I didn’t make it very far, and my three year old was faster than me, but I noticed a couple things and wanted to check with you.
First of all, I felt the most comfortable almost completely running on my toes. Is that sustainable, or am I going to set myself up for other problems (foot or on up)? I appreciate the info about limiting heel strike in the post above, but not sure how little heel strike I can actually get away with.
Second, I felt like I was holding my breath the entire time. I can’t figure out how to breathe normally and run.
I guess I am completely re-learning how to run.
Just looking for any insight,
Thanks,
Emily

Emily,
You are right on track. Everything you are feeling from feeling best on your toes to feeling as though you are holding your breath is right on track. I remember those same feelings. This is a great sign that you have great body awareness!
Recognize in my blogs how I talk about allowing your pelvic floor to adapt to the new level of stress. I would recommend cross training so that you are running every other day to allow your pelvic floor muscles some recovery time. It is fine to start running on your toes. You will have less impact this way and I want you focusing on a decreased heel strike and an increased push off. Your running style will gradually relax and adjust. For now, go with what feels right. You mentioned running slow, but recognize that there is less impact with more speed so look to run a bit faster with a forward lean and good push off.

As for breathing. You will feel as though you have to keep your TA sucked in manually as you start running. This as well will gradually relax as your body adapts to this new level of strength and stability. Give it time and it will happen naturally.

Also, beware of running down hill right now. Walk down hills until you feel more comfortable running.

I am really excited for you. My only other piece of advice is to listen to your body. There may be times during your cycle that your pelvic bowl is more inflammed and running can irritate it. You will recognize these times…it may be during ovulation or just before menstruation…or not at all.

Feel free to ask questions and please continue to update us as you progress toward your goal.

I bought ha-bit 2 month’s ago and i try to do a combination of workout 1 and 2 everyday and breast stroke swimming and the elliptical for my cardio. I also use the athena pelvic floor trainer.
1. Am I doing too much pelvic floor exercises?
2. Can I do reverse abdominal exercises without making my prolapse worse?
3. Can I do your workout 2 if I am pregnant?
4. On the elliptical machine, doing a hill exercise with resistance- would it aggravate my symtoms ?
5. Can swimming with a prolapse cause infection that may harm the baby

Hi. I’m new to prolapse and was very althletic before. I mostly did running, kickboxing and cross training with a lot of jumping. Know I need to modify now and trying to figure it out. I know biking and swimming are ok. I love spin class but there is a lot of hard uphill type pedaling to get a good workout. I noticed I draw mt stomach and belly button in on those slow hard parts. Is that ok? And what about walking on treadmill with incline up high? Trying to figure out ow to keep my level of cardio without the jumps or running or kicks. Oh, and what about stair step machine up high so it’s hard slow climbing? Thank you so much in advance!

Mom3,
The “draw your stomach in is always good as long as it isn”t accompanied with a tail bone tuck under. On a bike, your tail bone is consistently lifted so you are good!

You can definitely walk or climb on a serious incline without worries. When outdoors, I tend to run backward downhill to stay on my toes and minimize the hard heel strike that can accompany the deceleration when going downhill. You will find lots of workouts that you can do as you progress your strength. With your description of activities, I would highly recommend our Advanced Stabilization program for you to be sure your TA, Multifidi, and pelvic floor are all co-contraction during intense workouts.

thank you Tasha! Your blog has made me feel so much better during this stressful discovery. I love to workout and at first felt like my life as I knew it was over. But I am finding ways to keep it going and your story is inspiring. I ordered the hab-it dvd but will also get the Advanced stabalization program too. 🙂 Thanks so much for your reply. Glad to know I can still push myself safely without making my prolapse worse. 🙂 I love to run too and I’m so glad to see that you are able to keep running. I am waiting until after my uro-gyn consult to do anymore running b/c I’m so nervous about making this worse…but I’m hoping to get back there eventually.

1. Should I stop all cardio until I complete at least 6 weeks of the habit DVD, and the advanced 7 day workout?
2. With stage 2 prolapse, do you think I’ll ever run again? Marathons? It’s really hard to imagine right now as I feel pressure when walking in the mall for an hour.
3. Any tips for prolapsed mommies who want to have more babies in future?

Again, huge thanks for all that you have done and are doing for people like me! There’s hope 🙂

You don’t have to stop all cardio, but I would encourage non-impact. Get in the pool or get on a bike as you work your way, patiently and deliberately, through the Hab It program for 4-6 weeks and then onto the Advanced Program for another 4-6 weeks.

Remember you want to recruit each individual muscle of the pelvic basket and the dvd will help you do this and then as your goal progresses to higher intensity activities you will require the higher level of stability you can establish through the Advanced exercises.

Yes, I do believe you will run again. If you were a runner before, your muscle memory will help you get back there as long as you take all the steps needed to re-establish your pelvic basket firing pattern. I remember feeling significant symptoms just walking around the block! so many of us have been where you are!

My tips for future pregnancies are to do your homework now. Read through my blogs. Another good resource is http://www.prolapsehealth.com for nutrition and other tips. Read through the “Ask Tasha” section. For years to come you will continue to develop a better understanding of your posture and your body needs. Consistency with a thorough pelvic basket program will be key, carried over throughout your day with neutral spine posture. You will be healthier in the long run for the challenge you are experience with your pelvic floor. Your thorough rehabilitation of your prolapse will, without a doubt, prevent future orthopedic problems!